State of Community Health at Medak District

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Publication - October 26, 2004

An Introduction to Medak
Medak district with an area of 9702 km², is located in the North-eastern part of Andhra Pradesh. Located on the banks of the Manjira River, a major tributary of the Godavari, this area was predominantly an agricultural landmass. However, in the last few decades Medak has been transformed into an industrial belt as part of the government’s drive to industrialise backward areas. The Patancheru Industrial Estate was set up in 1975 as part of government initiative to bring in more industries to the state of Andhra Pradesh. Subsequently industrial areas grew in Khazipally, Bolaram, Pashamailaram, Bonthapally, Gaddapotharam and other places in Medak District. Over a period of 29 years, about 320 industries that manufacture pesticides, chemicals, pharmaceutical and steel rolls have mushroomed in this area. While arguments in favour of this expansion were and are being presented from an economic standpoint, the possible environmental and public health impacts have not been adequately considered. The Central Pollution Control board has identified 24 critically polluted areas in India. Patancheru of Medak District, is one of them.

Executive summary:Background
During the development of these industrial estates, no effort was made by the industrial units to integrate environment management measures to prevent the adverse impacts of industrial discharges. There are few or no mechanisms for the safe treatment and release of effluents. In fact, the industries have been deliberately disposing their wastes into the nearby land and water bodies. The Nakkavagu stream that flows through the industrial estate in Patancheru bears the brunt of waste disposal of over 100 industries, including paint, plastic, chemical and bulk drug industries. A few decades ago this stream was clean enough for surrounding villages to use for irrigation and drinking purposes. Pollution to this stream has destroyed approximately 2000 acres of farmland besides contaminating well water to the level of 140 feet1. Hazardous wastes found in the water include persistent organic pollutants, heavy metals, and other organic and inorganic chemicals. The common effluent treatment plant (CETP) located at Patancheru has proved inadequate in dealing with the problems posed by the toxic effluents. In fact, reports indicate that the CETP has been a major cause for further pollution2.
Amongst communities located in the midst or on the periphery of these vast industrial zones, there is a strong perception that the industrial processes employed in the region are highly polluting and have a direct negative impact on the health of residents3. Despite representatives of the communities repeatedly voicing their concerns, no concrete and sustained action has been taken by concerned authorities like the Pollution Control Board, to investigate further, and to curtail the ongoing environmental catastrophe, perpetrated by the polluting industries located here.
From their inception to date, most of the industries in the region, have not shared information regarding pollutants and their chronic and acute effects, with the local residents or the local authorities, as envisaged by the Factories Act and Rules under the Environment Protection Act 1986. Disaster management and emergency preparedness procedures are not in place and the medical fraternity of the region is not equipped with the necessary information to treat pollution related health problems.
The destruction of the environment has directly impacted human survival. There has been a sharp rise in morbidity rates, from 10.18% in 1991, to the current rate of 25.49%. Increasing trends of ailments associated with orthopaedic and skin problems have been reported4. Elevated levels of heavy metals have been detected in blood, urine, hair and nail samples of people here, a result of the consumption of industrially contaminated water and vegetables grown in the polluted soils5
The people of Medak have been protesting the destruction of their habitat, livelihoods and health for over two decades now. The pollution at Medak district has been established by sampling missions and studies by various organisations over the past decade or so6. However the legal process, now in its fifteenth year, continues to proceed at a slow pace.
The Health Study
The health study in Medak District was conducted in nine study villages and four control villages, and comprehensive information was gathered, relating to the health of 10,874 individuals from 9 villages in the study group and 4 villages in the control group. Of these 8,925 were from the study group and 1,949 from the control group.
This is a comparative study, where diseases as reported by the respondents of the study group, were compared with those reported by the control group. The control group was chosen on the basis of its similarity to the study group on a variety of relevant and important parameters like socio-cultural composition of the communities, diet, income levels, and ethnicity. Other important factors matched were derived from the “Determinants” and “Processes” of the “Indicators that Count” framework8 developed by Hancock and others. The only real defining difference between the 2 groups is the exposure to pollution in the study group. There is no industrial activity of consequence at the control locations as compared to the study locations.
An alliance was formed with Occupational Health and Safety Centre (OHSC) and Lokmanya Tilak Medical College (LTM), wherein their doctors visited the field to medically verify the diagnoses of certain diseases. This was a vital part of the study.
Among the various existing typologies of research in community health, this particular study falls under the category of ‘Intervention Outcome Research’, which is meant to lead to action from the concerned parties, in the direction of affirming the rights of affected communities.
The methodology is based on an earlier scientific study at Eloor, Kerala, undertaken by Greenpeace India, on the effects on human health caused by exposure to a combination of chemicals in the land, air and water9. The adaptation of the research to suit the conditions at Patancheru, was done in consultation with the advisory board.
Features of the health study include
1. Care was taken to obtain community consent to conduct the study and to ensure participation and co-operation from the local authorities and leaders.
2. Setting up of an advisory board of medical experts who helped in the design of the study and monitored its progress. The meetings with the advisory board helped in resolving vital issues like scientific biases, sampling sizes /ratios, training modules for interviewers, study ethics, selection of study and control groups and statistical analysis.
3. A comprehensive literature survey of all available material on the environmental and human health status of Medak.
4. An open ended exploratory questionnaire administered using the random stratified sampling method
5. The training of the interviewers, a community sampling exercise and a pilot survey to identify practical difficulties involved in the field investigation.
6. Adherence to all ethical norms. Voluntary prior informed written consent obtained from each participant.
Analysis and Findings
The analysis was restricted to simple percentage analysis, followed by calculation of the odds-ratio. Manual calculations along with a customised software management system, designed and developed in Access were used to reach the figures on prevalence percentages, incidence, statistical significance and overall patterns.
The results of this study demonstrate that all body systems without exception are adversely affected in the study areas as opposed to the control locations. It is clear that the cocktail of poisons in the air, water and land of the study villages have considerably affected the health and well being of the local population. The morbidity figures due to pollution related illnesses like cancer, asthma and bronchitis and heart diseases are very high. There is a statistically significant increase in confirmed cases of respiratory illnesses.
Recommendations and Remedial Action
The implications of these findings are serious. The study demonstrates that the health of the residents of Medak is being significantly affected by the current levels of industrial activity. It is incumbent upon the state regulatory authorities responsible for public health to investigate this matter, to further define the scope and severity of the problem, and to initiate processes which will return the community to the state of health enjoyed by them prior to this era of reckless industrialisation.
It is evident that the people living around these industrial estates have not received justice even after all these years. Their fundamental right to clean air and water continue to be robbed by greedy criminal corporations, with pliant bureaucracies turning a blind eye to the situation.
Keeping the above facts in mind, Greenpeace demands:* The state and industries must provide immediate health assistance to the communities at Medak , and also undertake long term medical rehabilitation of affected persons
* The government must declare a state of chemical crisis in the area with immediate effect
* Zero discharge of toxic effluents into water bodies with immediate effect
* Full disclosure of chemicals in the industrial products, processes and wastes generated at Medak. Comprehensive information about the health effects of these chemicals to be made available to the communities.
Significance of this Health Study
1. While many studies have been undertaken in the Medak district, this independent study has surveyed a significantly large sample size of 10,874 people.
2. Communities have a “Right To Know” about findings regarding their locality, which impact their health and livelihoods. Greenpeace intends to make this report available to the community in both English and Telugu.
3. The most vulnerable section of the population, children are being severely affected in terms of their health and development and in effect being robbed of their futures.
It is hoped that this health study, will be an effective tool in fore-fronting the widespread abuses to the environment and hence to human health.
The first part of the report follows.
click here to See Report (part2)